Unit 5 - Case Study for COPD - Summer 2023

.docx

School

Weber State University *

*We aren’t endorsed by this school

Course

2300

Subject

Health Science

Date

Apr 3, 2024

Type

docx

Pages

Uploaded by LieutenantFangToad13

Case Study: COPD / Emphysema Clarence Beeks is Government analyst for orange juice production and is 66 years old. He is admitted to your medical floor for exacerbation of his COPD (chronic obstructive pulmonary disease/ emphysema). Past medical history includes: HTN which is controlled with Enalapril for the past 5 years. He has been treated for pneumonia yearly for the past 4 years. He presents as a cachectic male with a “barrel” chest. He is experiencing difficulty breathing and he tell you that he is a 1–2 pack a day smoker for 35 years. He sleeps poorly and C/O’s of constant fatigue. “I don’t have the energy to even mow my lawn”, “my wife had to hire a lawn service”, “What kind of husband is that?” Vital Signs: 164/ 86, 122, 37, 101.5 F. SaO2=86% Admitting orders: O2 to maintain SaO2 of 90%, IV of D5W at 50ml/hr., intake and output, ABG’s , CBC with Differential, BMP and Theophylline ( Theo-Dur) level , chest x-ray, prednisone 60 mg/day po, Doxycycline 100 mg po q. 12 h. x 10 days. Azithromycin 500 mg IVPB. Q 24 hr. x 2 days then 500mg. PO x 7 days, theophylline 300 mg po bid, heparin 5000 units SC q 12 h. Albuterol 2.5 mg ( o.5 ml) in 3 ml normal saline and ipratropium 500 mg by nebulizer q4-6 h enalapril 10 mg PO q am. Clarence asks you, “What is going on in my lungs, I can’t breathe” 1. Explain the pathophysiology of emphysema: - Emphysema affects the air spaces distal to the terminal bronchiole. It occurs when the healthy alveoli of the lungs are exposed to harmful particles that become trapped in the alveoli. One main harmful particle that causes emphysema is smoke inhalation. When these particles become trapped, an inflammatory response is triggered. Because of the severity and continuous harmful particles getting trapped, the inflammatory chemicals dissolve the alveolar septum, and air cavities lined with carbon deposits form. There is limited airflow in and out of the lungs and a deprived flow of oxygen through the body because of the damaged alveoli. 2. Explain the reason Clarence’s Vital Signs are abnormal. - Clarence's vital signs are abnormal because his body does not have the oxygen that it needs. His blood pressure is high because his body is trying to produce more red blood cells to compensate for the low oxygen levels and increased CO2 levels. He is also trying to increase his oxygen with an increased respiratory rate/ rapid breathing. The increased heart rate and low O2 stats are also due to his hypoxia. His high temperature could be because of a possible respiratory infection which could also contribute to his other vital signs being abnormal. “I feel like I have a bag over my head and I’m suffocating, what can you do to help me “ 3. Identify 3 measures you could try, to improve oxygenation for Clarence. / Include Pulmonary Hygiene 1. Encourage and teach pursed lip breathing to help relax his airways 2. Teach good posture, both sitting and standing as slouching can make it more difficult to breathe. 3. Encourage increasing activity. He should start small and work his way up as this will make a significant difference in his day-to-day breathing. Other: Drink plenty of water, prioritize sleep, nutrition, avoid smoking

Clarence’s dinner tray arrives, “I’m so hungry, I could eat a horse”. You notice him rapidly consuming the mashed potatoes. When you pick up the tray, you notice that he hasn’t touched anything else. When you question him, he states, “I don’t understand it. I can be so hungry, but when I start to eat, I have trouble breathing and I have to stop.” 4. Explain the phenomenon of carbohydrate loading which may increase the workload of breathing to Clarence. Offer suggestions to Clarence to help him with meals and SOB.  Phenomenon carb loading: Carbohydrates produce more carbon dioxide in the body. So, if a patient with COPD eats a lot of carbs, this will increase their difficulty breathing as they will have a hard time breathing out this CO2.  Meals suggestions for SOB: Include more proteins and fats rather than carbs in all meals. Offer 3 suggestions to help improve his caloric intake A. Eat a good source of protein in all meals with a lower amount of carbohydrates as this will make it harder for you to breathe and will not let you eat as much as you need. B. Try to eat 6 small meals a day instead of 3 large ones because digestion requires energy and which requires oxygen. C. Drink plenty of fluids and avoid rushing your meals. Take time to digest and rest before, during, and after eating. 5. Clarence is ready for discharge 5 days later: his oxygen level is 91% on room air. List 6 educational topics that you need to explore with Clarence and his wife to help manage his disease and reduce the risk of exacerbation. A. Encourage smoking cessation or at least a reduction in the number of packs per day. B. Take your medications as the doctor has ordered. C. Teach proper nutrition with techniques to increase caloric intake and lower SOB when eating. D. Regularly see your provider and notify of increased symptoms. E. Encourage increasing his activity level. Help teach him that at first it will be difficult and make you feel worse sometimes, but strengthening his lungs through physical activity will greatly help with his regular daily living. F. Encourage individualized pulmonary rehabilitation. other: increase fluids, encourage family participation Clarence’s wife Gloria pulls you aside after your teaching and says to you, “I don’t know what to do, he used to be so active before he retired a year ago. He’s lost 30 pounds and is even afraid to take a bath alone. It takes him hours to dress if he even dresses for the day. He always wants me with him, but if I try to talk to him, he snaps and snarls at me, anything I do irritates him. I must keep working to pay the bills, I must be able to support myself after he is gone. He calls me several times a day to try to get me to come home, but I can’t go home, I must work. Honestly, some days I don’t even want to come home. He was so active in his government job working with orange juice. 5. How do you respond to Gloria’s statement? - First and foremost, I would empathize with Gloria and explain to her that I understand the situation and support her. I would explain that COPD is difficult to manage and because of Clarence's complicated health history, he does need your help and monitoring. She will be a critical factor in Clarence's recovery and hopeful independence. I would suggest that she helps make the changes Clarence needs together, with him. This can include being active with him, cooking the meals, buying the food, and eating the diet he needs to eat. I would also encourage her to be honest with him about how she feels. I would even suggest a possible therapist to help guide them both through this tough situation.

6. References: Hinkle, J. L., Cheever, K. H., & Overbaugh, K. J. (2022). Brunner & suddarth’s textbook of medical-surgical nursing (15 th ed.). Wolters Kluwer. Robins, A. G. (2021). Pathophysiology of emphysema. Clinics in Chest Management, 4 (3), 413-420. https://doi.org/10.1016/S0272-5231(21)00217-3

Your preview ends here

Eager to read complete document? Join bartleby learn and gain access to the full version

Access to all documents
Unlimited textbook solutions
24/7 expert homework help